but a few highlights:
Q. Is government involvement in health care un-American?
A. There is a long American tradition of public responsibility for health. In the 19th century, for instance, states devoted as much as 30 percent of their budgets to public mental health care. And when it became clear that vaccination actually worked against smallpox, state after state created labs to provide vaccines free of charge to citizens. So to say it’s un-American is profoundly wrongheaded.
You sound like an anti-doctor muckraker.
I’m not. I believe most physicians are caring professionals. But because of the way our health-care system evolved, bad doctors are rarely held accountable for their mistakes. Under 5 percent of doctors account for roughly a third of malpractice suits, yet the system lets them keep their licenses.
What about early efforts to provide national insurance?
In 1915 and 1916, bills were introduced into Congress that would have produced a structure similar to those in place today throughout Western Europe. Initially the AMA—the American Medical Association—was all for it. After all, doctors had been accustomed to collecting only 50 percent of their bills, so 100 percent looked like a good deal. National insurance seemed inevitable. But the AMA soon began to shift its position.
Doctors’ incomes and medical costs continued to rise steadily in the 1920s. In 1932 the Committee on the Costs of Medical Care, a national blue ribbon panel that included the AMA, again recommended a national insurance program. But a committee minority said that would destroy the medical profession. The AMA claimed this minority represented the majority of physicians—although no one could ever calculate whether that was true—and killed that initiative too.
What about Medicare and Medicaid?
The AMA initially fought the proposals, calling them a government takeover. But this time—in the progressive 1960s—they lost. Ironically, they realized, “Wow, were we ever wrong! Now we have this government spigot of money pouring into the largely unregulated world we created in the 19th century.” That’s where the real acceleration of medical costs started.
Can the free market fix the system?
No. Health is not a free market commodity, a good you can choose, like a car. People are willing to spend everything they have and whatever they can borrow for health.
Would a public plan lead to rationing care?
We ration it already, on an ability-to-pay basis. Yet we also pay for those who can’t, in subtle and indirect ways like soaring emergency room expenses charged to taxpayers, and a less healthy and productive citizenry overall. We need to adjust this malfunctioning distribution system to make our health-care dollars go much farther.
How do we fix it?
Doctors have a vested interest in you getting sick. They are paid to get you better—and generally the more that costs the more they make. We need to change that incentive. If doctors were salaried—and we can afford handsome salaries—to maintain people’s health in the most effective, not most expensive, manner, we would have a far better structure. Around the country there are plenty of small practices and some big ones that do that and work very well indeed.